The contribution of community health workers to the control of Buruli ulcer in the Ngoantet area, Cameroon.

INTRODUCTION: Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans. It is the third most common mycobacterial infection after tuberculosis and leprosy. Community Health Workers (CHWs) hold the potential to support patients and their families at the community level. METHODS: We conducted a cross-sectional descriptive study to assess the participation of CHWs in the early diagnosis and treatment of BU in Ngoantet, Cameroon. The CHWs performance was measured using: the number of cases referred to the Ngoantet Health Centre, the percentage of accomplished referrals, the percentage of cases referred by CHWs confirmed by the staff of Ngoantet Health Centre. Data was analyzed using Epi-info version 3.4.1. and Microsoft Office Excel 2003. The study focused on 51 CHWs in the Ngoantet health area. RESULTS: The referral rate was 95.0%. Most of the suspicious cases (91.5%) referred were confirmed by health workers. Most CHWs (78.4%) declared that they had identified at least one presumptive case of BU infection. CONCLUSION: We conclude that the CHWs can play a key role in scaling up BU control activities using a referral system. This study confirms the role of home visits and inspections in the early detection and treatment of BU.

[An effort to discontinue the use of verbal change of shift reports in a workplace with both nursing staff and personal support workers--encouraging independent information collection by personal support workers].

The change of shift report is of great importance in nursing in order to ensure the continuity of care, transfer information among nurses, and to ensure the transfer of responsibility from one shift to the next. In workplaces where nursing staff work together with personal support workers, it is important for staff to have common access to patient information in order to be able to use the information practically and carry out their individual responsibilities and roles. Until now, nursing staff and personal support workers collaborated and combined information for the verbal change of shift report, but the role of the personal support worker was in practice, more passive. Beginning 3 years ago, nurses began planning training sessions to educate personal support workers to increase their practical abilities. Through the training, personal support workers learned how to leave accurate patient records and nursing staff and personal support worker staff began to use a joint flow sheet to keep a record of patient information. This written record became the means of communication, making the verbal change of shift report redundant. As a result of trying to discontinue the verbal change of shift reports, personal support workers began to collect information more independently, and began to practice care more intentionally. In addition, the understanding of the role of the personal support worker deepened, the ability to care for patients improved, and it also led to better cooperation between nursing staff and personal support workers.

Integrating community-based rehabilitation and leprosy rehabilitation services into an inclusive development approach.

Community-based rehabilitation (CBR) has been described as a strategy for leprosy rehabilitation. Developments in CBR and leprosy rehabilitation services, including Socio-economic rehabilitation (SER) show that both approaches aim to become part of a community development process. The basic assumption is that people with disabilities will benefit most from being included in mainstream programmes implemented in their own community, e.g. programmes aiming to improve livelihood. These developments have a decisive impact on the roles of all people involved in the rehabilitation process. Where the emphasis in the rehabilitation process shifts to the community and becomes part of community development, the rehabilitation workers need different competencies than were required in vertical disability programmes. This article focuses on the changing roles of mid-level rehabilitation workers and trainers and therapists. In many programmes a mid-level cadre was introduced to work with people with disabilities and their families. Consequently, trainers and therapists have moved away from direct, hands-on interventions and focussed on training this mid-level cadre and offering specialised referral services. This system was primarily developed to provide treatment at all levels, including community level. However, when rehabilitation becomes part of a community development process there is a need for 'change agents' and a structure that supports them. The success of integrating disability specific programmes like CBR and SER, into inclusive development programmes will depend largely on the extent to which rehabilitation workers are able to reinvent themselves as 'change agents' and redefine their roles, positions, and competencies.